older is 3.1 percent. Men are more likely than women to have had a heart attack. The prevalence among non-Hispanic white men and non-Hispanic black men is the same (4.3 percent), while Mexican American men are less likely to have had a heart attack (3 percent). Both non-Hispanic white women and non-Hispanic black women experience higher rates of heart attack (2.1 and 2.2 percent, respectively) than do Mexican American women at 1.1 percent. Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) show the highest prevalence of heart attack is in West Virginia (6.5 percent) and Kentucky (5.9 percent). The lowest rate (1.9 percent) was reported in the District of Columbia. West Virginia also had the highest prevalence of angina or coronary heart disease, while the District of Columbia had the lowest (Roger et al., 2010).

Stroke

About 7 million Americans aged 20 or older have had a stroke. Each year approximately 610,000 experience their first stroke and another 185,000 experience a recurrence (AHA, 2009). Approximately 87 percent of all strokes are ischemic; 10 percent result from intracerebral hemorrhage and 3 percent result from subarachnoid hemorrhage.

Approximately 2.7 percent of men and 2.5 percent of women aged 18 or older have a history of stroke. According to the 2009 BRFSS, the states with the highest prevalence of stroke were Alabama and Oklahoma, and the lowest was Colorado (Roger et al., 2010). NHLBI reports that blacks have nearly twice the risk of first-time stroke when compared with whites. The age-adjusted stroke incidence rates at ages 45–84 are 6.6 per 1,000 persons in black males, 3.6 in white males, 4.9 in black females, and 2.3 in white females (NHLBI, 2006).

Data from the Strong Heart Study found that incidence of stroke was 6.8 per 1,000 persons (age- and sex-adjusted) in American Indians (Zhang et al., 2008). Data from the 2005 BRFSS also showed that the prevalence of stroke was higher among American Indians/Alaskan Natives and multiracial persons than among whites. Increased incidence of stroke has been reported among Mexican Americans when compared with non-Hispanic whites. Stroke symptoms are more commonly reported among individuals with fair to poor perceived health status and those with lower income and educational attainment: approximately twice the proportion of those with less than 12 years of education reported a history of stroke compared with college graduates (HHS, 2006).

Hypertension

Approximately 76.4 million—one in three—American adults have high blood pressure (hypertension), defined as an elevated pressure of 140 mmHg systolic or higher and/or 90 mmHg diastolic or higher, use of antihypertensive medication, or being told at least twice by a physician or other health professional that one has high blood pressure. National Health and Nutrition Examination Survey (NHANES) data collected between 2003 and 2006 reveal that among adults with hypertension, 78 percent were aware of their condition and 68 percent were using antihypertensive medication; however, less than 64 percent of those receiving treatment had their condition controlled (Roger et al., 2010).

The prevalence of hypertension increases with age. About half of individuals between the ages of 60 and 69, and three quarters of individuals over the age of 70, have hypertension. Framingham Heart Study investigators found the lifetime risk of hypertension to be approximately 90 percent for men and women who had normal blood pressure at age 55 or 65 and survived to ages 80–85. More men than women have hypertension before age 45, similar proportions of men and women experience hypertension between the ages of 55 and 64, and women are more likely to have hypertension later in life (NCHS, 2007). U.S. blacks have the highest prevalence of hypertension in the world. They develop the disease earlier in life, have much higher average blood pressures than whites do, and as a result have greater rates of nonfatal and fatal stroke, heart disease deaths, and end-stage kidney disease. The prevalence of hypertension increased among blacks and whites in the United States between 1999 and 2002, rising from 35.8 to 41.4 percent among blacks and from 24.3 to 28.1 percent among whites (Roger et al., 2010). Factors such as birth outside of the United States, speaking a language other than English at home, and fewer years spent living in this country are associated with lower rates of hypertension (Moran et al., 2007).



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